医联体全科团队对家庭医生签约服务患者体验的影响研究

doi:10.12114/j.issn.1007-9572.2019.00.407

摘要/Abstract

摘要： 背景　推广家庭医生签约服务是提高基层卫生服务能力的可行路径。相关研究表明医联体全科团队参与下的家庭医生签约服务能够提高居民对基层卫生服务能力的认可度，但这一模式能否增强签约居民的患者体验，还需要进一步研究和分析。目的　探讨医联体全科团队参与下的家庭医生签约服务模式对患者体验的影响。方法　选取2018年9—10月郑州市2家社区卫生服务中心辖区内签约居民为调查对象，其中林科社区卫生服务中心采用单纯社区家庭医生团队签约模式（社区家庭医生团队组），北下街社区卫生服务中心采用三级综合医院全科团队参与的家庭医生签约服务模式（医联体全科团队组），两社区各随机抽取签约居民500人。采用Picker患者体验量表（PPE-15）对签约居民进行问卷调查，调查内容包括：调查对象的基本情况、患者体验各维度得分及总体评价。分析与总体评价强相关的具体患者体验指标，提取两组患者体验指标差值公因子。结果　两组签约居民的年龄、性别、参保类型、健康自评状况、有无慢性病均无差异（P>0.05），文化程度差异有统计学意义（P<0.05）。医联体全科团队组居民就诊体验总体评价得分高于社区家庭医生团队组（P<0.05）；医联体全科团队组在家人或朋友参与、医疗服务的连续性2个维度的得分高于社区家庭医生团队组（P<0.001），而在信息传递与患者教育这一维度的得分低于社区家庭医生团队组（P<0.05）；两组签约居民在情感支持、尊重患者的偏好、生理舒适3个维度的得分无差异（P>0.05）。4个维度（信息传递与患者教育、情感支持、家人或朋友参与、医疗服务的连续性）的患者体验与签约居民就诊体验总体评价强相关。15个患者体验指标差值可归为交流沟通、情感支持、服务连续、信息传递、尊重患者权利5个公因子，累积方差贡献率为67.669%。结论　医联体下的家庭医生签约服务模式能够加强医疗服务的连续性，促进患者家人与朋友共同参与，增强签约居民的患者体验，但在信息传递与患者教育方面有待加强。

关键词: 家庭医生签约服务, 医联体, 患者体验, Picker患者体验量表

Abstract: Background　Promoting the contracted family doctor services is feasible to improve the service capacities of primary healthcare institutions.Relevant studies show that contracted family doctor services delivered by general practitioner team from a regional medical consortium can improve residents' recognition of service capacities of primary healthcare institutions，but whether this model can enhance their healthcare-seeking experience needs further research and analysis.Objective　To explore the experience of patients receiving contracted family doctor services delivered by general practitioner team from a regional medical consortium.Methods　This study was conducted among 1 000 randomly selected contracted residents who received health services from two community heath centers in Zhengzhou during September to October，2018，including 500 from Linke Community Health Center（control group）and 500 from Beixia Street Community Health Center（intervention group）.The control group received healthcare services delivered by community family doctors，while the intervention group received healthcare services delivered by general practitioner team from a regional medical consortium.When the interventions ended，Picker's Patient's Experience Scale（PPE-15）was used to survey the participants in terms of general personal data，evaluation for 8 domains of PPE-15（domain scores of PPE-15），and overall evaluation of the experience（total score of PPE-15），and indicators closely associated with overall healthcare-seeking experience.Common factors for the differences in experiences between the two groups were extracted.Results　Education level distribution differed significantly between the groups（P<0.05），but mean age，sex ratio，distributions of medical insurance types and self-rated health status，and prevalence of chronic diseases did not（P>0.05）.The intervention group had higher total PPE-15 score than the control group（P<0.05）.Compared with the control group，intervention group had higher scores in two domains（involvement of family & friends，and continuity & transition）（P<0.001），but had lower score in the domain of information & education（P<0.05）.Two groups had similar scores in three domains（emotional support，respect for patient preferences，and physical comfort）（P>0.05）.The scores of four domains（information & education，emotional support，involvement of family & friends，and continuity & transition）were strongly associated with the total PPE-15 score.The difference of 15 patient experience indicators can be classified into five common factors：communication，emotional support，service continuity，information transmission，and respect for patient rights，explaining 67.669% of the total variance.Conclusion　Our study shows that contracted family doctor services delivered by general practitioner team from a regional medical consortium helps to strengthen the continuity of medical services，promotes the involvement of family members and friends，and improves the healthcare-seeking experience in contracted residents.However, information transmission and patient education need to be strengthened.

Key words: Contracted family doctor services, Medical association, Patient experience, Picker's Patient's Experience Scale

张田,苗豫东,王留义,等. 医联体全科团队对家庭医生签约服务患者体验的影响研究[J]. 中国全科医学, 2019, 22(31): 3792-3796. DOI: 10.12114/j.issn.1007-9572.2019.00.407.
ZHANG Tian,MIAO Yudong,WANG Liuyi, et al. Impact of Family Doctor Services Delivered by the General Practitioner Team within a Regional Medical Consortium on Healthcare-seeking Experience of Contracted Residents　[J]. Chinese General Practice, 2019, 22(31): 3792-3796. DOI: 10.12114/j.issn.1007-9572.2019.00.407.

参考文献

［1］刘利群．推进家庭医生签约服务加强分级诊疗制度建设［J］．中国全科医学，2018，21（1）：1-4．DOI：10.3969/j.issn.1007-9572.2018.01.001.
LIU L Q．Promoting contracted services of family doctors to strengthen the construction of hierarchical medical system［J］．Chinese General Practice，2018，21（1）：1-4．DOI：10.3969/j.issn.1007-9572.2018.01.001.
［2］殷东，张家睿，王真，等．中国家庭医生签约服务开展现状及研究进展［J］.中国全科医学，2018，21（7）：753-760．DOI：10.3969/j.issn.1007-9572.2018.07.001.
YIN D，ZHANG J R，WANG Z，et al．Delivery status of contractual services from family doctors in China and advances in the related studies［J］．Chinese General Practice，2018，21（7）：753-760．DOI：10.3969/j.issn.1007-9572.2018.07.001.
［3］徐学萍，袁林林，孙晓杰．我国家庭医生签约服务开展中的“病症”与“良药”［J］．中国初级卫生保健，2018，32（10）：22-24．DOI：10.3969/j.issn.1001-568X.2018.10.0009.
XU X P，YUAN L L，SUN X J．Problems and solutions in the implement of family doctor's contract service in China［J］．Chinese Primary Health Care，2018，32（10）：22-24．DOI：10.3969/j.issn.1001-568X.2018.10.0009.
［4］王志翊，王仲，翁杰，等．医联体全科团队对居民家庭医生签约意愿的影响研究［J］．中国全科医学，2018，21（27）：3389-3392．DOI：10.3969/j.issn.1007-9572.2018.00.184.
WANG Z Y，WANG Z，WENG J，et al．The influence of general practice alliance on the residents' willingness to sign a family physician［J］．Chinese General Practice，2018，21（27）：3389-3392．DOI：10.3969/j.issn.1007-9572.2018.00.184.
［5］谢春艳，陈多，王常颖，等．上海市J区居民就医体验研究［J］．中国卫生事业管理，2017，34（10）：735-738．
XIE C Y，CHEN D，WANG C Y，et al．Research on health care experience of community residents in J District，Shanghai［J］．Chinese Health Service Management，2017，34（10）：735-738．
［6］王黔艳，周亚旭，方鹏骞，等．县级公立医院患者体验评价：基于Picker患者体验量表的实证研究［J］．中国医院，2017，21（9）：20-22．DOI：10.3969/j.issn.1671-0592.2017.09.006.
WANG Q Y，ZHOU Y X，FANG P Q，et al．Evaluation of patient experience in county-level public hospitals in China：an empirical study based on Picker's Patient's Experience Scale［J］．Chinese Hospitals，2017，21（9）：20-22．DOI：10.3969/j.issn.1671-0592.2017.09.006.
［7］侯胜田，王海星．我国公立医院医患沟通现状调查［J］．医学与社会，2014，27（9）：52-54．DOI：10.13723/j.yxysh.2014.09.016.
HOU S T，WANG H X．Investigation on the current status of doctor-patient communication in public hospitals in China［J］．Medicine and Society，2014，27（9）：52-54．DOI：10.13723/j.yxysh.2014.09.016.
［8］刘春富．区域医疗信息共享与分级诊疗结合模式研究［J］．观察与思考，2012，29（8）：76-77．
LIU C F．Research on the combination of regional medical information sharing and graded diagnosis and treatment［J］．Observation and Ponderation，2012，29（8）：76-77．

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